Diagnosis and Staging of Inflammatory Breast Cancer

Because inflammatory breast cancer forms in layers, your doctor may not feel a distinct lump during a breast exam and a mammogram may not detect one either. However, it is possible to see and feel the skin thickening that often happens with IBC. This skin thickening can also be detected on a mammogram.

In most cases, inflammatory breast cancer is diagnosed after you or your doctor can see or feel breast changes such as redness, swelling, warmth, or an orange-peel look to the skin. Because IBC grows quickly, it is usually found at a locally advanced stage, meaning that cancer cells have spread into nearby breast tissue or lymph nodes. Just about all people with IBC have evidence of cancer in the lymph nodes. In approximately 1 out of 3 people with IBC, the cancer has spread from the breast to other areas of the body.

If you’ve been diagnosed with inflammatory breast cancer, it’s completely understandable if you’re feeling overwhelmed. Keep in mind, though, that there are a variety of treatment options available for IBC.

Tests for diagnosis and staging

To diagnose inflammatory breast cancer, your doctor will perform a biopsy. Biopsy is a surgical procedure that removes some of the suspicious breast tissue for examination under a microscope.

Because inflammatory breast cancer usually does not begin as a distinct lump, but instead as changes to the skin, a skin punch biopsy is often used to make the diagnosis. During this type of biopsy, the doctor uses a circular tool to remove a small section of the skin and its deeper layers, and then stitches the wound closed. If your doctor can see a distinct lesion, he or she may perform an ultrasound-guided core needle biopsy. Ultrasound is an imaging method that places a sound-emitting device on the breast to obtain images of the tissues inside. Guided by the ultrasound, the doctor inserts a hollow needle into the breast to remove several cylinder-shaped samples of tissue from the area of suspicion.

If the biopsy shows that inflammatory breast cancer is present, your doctor will order additional tests to figure out how much of the breast tissue and lymph nodes are involved, and whether or not the other breast is affected. Breast MRI, or magnetic resonance imaging, is considered the most reliable test for gathering more information about inflammatory breast cancer.

Once IBC is diagnosed, additional tests are used to determine whether the cancer has spread outside the breast to other organs, such as the lungs, bones, or liver. This is called staging. Tests that may be used include:

chest X-ray

CT scan (computerized tomography) of the chest, abdomen, and pelvis

bone scan

liver function tests

Some researchers are studying the usefulness of PET/CT scans in staging inflammatory breast cancer. A PET (positron emission tomography)/CT scan is a newer technology used to create images of the body’s cells as they work. First, you would be injected with a substance made up of sugar and a small amount of radioactive material. A special scanning machine then “highlights” any cancer cells throughout the body as they absorb the radioactive substance. Whether PET/CT is better than other tests at staging the cancer is yet to be determined.

Although PET/CT is still being studied, you may want to ask your doctor whether this test would be useful in your treatment planning. If the answer is “yes,” you can ask where PET/CT might be available in your area.

Stages of inflammatory breast cancer

Once the staging tests described above are completed, you doctor will describe the inflammatory breast cancer as stage IIIB, stage IIIC, or stage IV.

Stage IIIB means the cancer has spread to tissues near the breast, such as the skin or chest wall, including the ribs and muscles in the chest. The cancer may have spread to lymph nodes within the breast or under the arm.

Stage IIIC means the cancer has spread to lymph nodes beneath the collarbone and near the neck. The cancer also may have spread to lymph nodes within the breast or under the arm and to tissues near the breast.

Stage IV means that the cancer has spread to other organs. These can include the bones, lungs, liver, and/or brain, as well as the lymph nodes in the neck.

Tests for hormone-receptor and HER2-receptor status

In addition to figuring out the stage of the cancer, your doctor will test a sample of the cancerous tissue for estrogen, progesterone, and HER2 receptors.

Hormone-receptor status: This test is used to figure out whether or not the breast cancer has receptors for the hormones estrogen and progesterone. A positive result means that estrogen or progesterone (or both) is fueling the cancer cells’ growth. Most inflammatory breast cancers are hormone-receptor-negative. If the cancer is hormone-receptor-positive, however, your doctor can choose treatments that block or lower estrogen.

HER2-receptor status: Another test is done to find out whether the breast cancer cells make too much of a protein called HER2. If they do, then they also have too many HER2 receptors at the cell surface. With too many receptors, breast cancer cells pick up too many growth signals and start growing too much and too fast. One way to slow down or stop the growth of the cancer cells is to block the receptors so they don't pick up as many growth signals. That’s what the medication called Herceptin (chemical name: trastuzumab) does. Many inflammatory breast cancers are HER2-positive, which means they can be treated with Herceptin.

For more information about estrogen-receptor and HER2-receptor status, please visit Your Diagnosis.